Posterior tibial plateau fracture treatment with the new WAVE posterior proximal tibia plate: feasibility and first results

Berg, J. van den; Reul, Maike; Vinckier, Olivier; Derksen, R.J.; Nijs, Stefaan; Verhofstad, M.H.J.; Hoekstra, Harm

doi:10.1007/s00068-021-01639-7

Cited by 7 publications

(3 citation statements)

References 20 publications

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“…In addition to improving various surgical procedures, the corresponding internal fixation plates for posterolateral column tibial plateau fractures are constantly being improved and innovated. Berg et al [19] invented a new WAVE posterior proximal tibia plate with a 12° diaphyseal axial twist and an additional 15° metaphyseal axial twist. This plate was more consistent with the anatomical structure of the posterior tibia, and the horizontal arm of the plate can provide both posteromedial and posterolateral support.…”

Section: Discussionmentioning

confidence: 99%

Treatment of tibial plateau fractures involving the posterolateral column using the extended anterolateral approach

et al. 2021

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To summarize the surgical technique and clinical effects of the extended anterolateral approach for the treatment of Schatzker type II and Schatzker type V/VI involving the posterolateral column tibial plateau. From January 2015 through December 2018, 28 patients with tibial plateau fractures involving the posterolateral column were included in the study. Among them, 16 patients were Schatzker type II treated using an extended anterolateral approach with lateral tibial locking compression plate fixation. Twelve patients were Schatzker type V or VI treated using an extended anterolateral combined with a medial approach using lateral tibial locking compression plate plus medial locking compression plate fixation. All cases were followed up for 15 to 31 months, with an average follow-up of 22.5 ± 3.7 months. During the follow-up, the tibial plateau angle (TPA), lateral posterior angle (PA) and Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation; the Hospital for Special Knee Surgery score and the range of motion were used to evaluate knee function. Additionally, the Lachman and knee Valgus (Varus) stress tests were used to evaluate anteroposterior and lateral stability of the knee. All fractures healed. At the 12-month follow-up, the Schatzker type II group revealed a mean TPA of 86.38 ± 3.92°, a mean PA of 7.43 ± 2.68°, and a mean Rasmussen radiological score of 16.00 ± 2.06 points. The Schatzker type V/VI group showed a mean TPA of 84.91 ± 3.51°, a mean PA of 9.68 ± 4.01°, and a mean Rasmussen radiological score of 15.33 ± 2.99 points. During the 1-year follow-up, when the postoperative PA was re-measured, the TPA and Rasmussen score of the 2 groups did not change significantly ( P > .05). At the last follow-up, the Schatzker type II group showed a knee flexion angle of 110° to 135° and a mean HHS score of 88.37 ± 10.01 points. The Schatzker type V/VI group revealed a knee flexion angle of 100° to 130° and a mean HHS score of 82.17 ± 10.76 points. Additionally, up to the last follow-up, the Lachman and knee Valgus (Varus) stress test results of the 2 groups were negative. No complications were found. The extended anterolateral approach is a good choice to treat tibial plateau fractures involving the posterolateral column.

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Section: Discussionmentioning

confidence: 99%

Treatment of tibial plateau fractures involving the posterolateral column using the extended anterolateral approach

et al. 2021

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“…The limitations of this study are as follows. The experiment gave a single axial static load, but the real tibial plateau force is multi-directional and dynamic ( 23 ), and the failure of fracture fixation may also be caused by repeated application of load. The finite element model is an ideal model and ignores the impact of soft tissue on the surrounding Impact, only consider the excellence of the internal fixation from biomechanics.…”

Section: Discussionmentioning

confidence: 99%

Finite element analysis of a novel anatomical plate in posterolateral plateau fractures

Jian,

Jiang,

et al. 2024

Front. Surg.

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ObjectiveThis study aims to analyze the biomechanical characteristics of posterolateral plateau fractures fixed by a novel anatomical plate using finite element analysis.MethodsA three-dimensional digital model of the full length of right tibiofibula was obtained by CT scanning. A posterolateral tibial plateau fracture model was then created. The acquired fracture model was assembled with 4 groups of internal fixations: Group A, novel anatomical plate; Group B, straight buttress plate; Group C, oblique T-shaped locking plate; Group D, two lag screws. Axial loads of 500, 1,000 and 1,500 N perpendicular to the horizontal plane were used to simulate the stress on the lateral plateau of a 65 kg person standing, walking and fast running.ResultsVertical displacements of the posterolateral fragments in each of the four groups gradually increased under loads from 500 N to 1,500 N. The maximum displacement of the fracture fragment in four groups were all located on the lateral side of the proximal part, and the displacement gradually decreased from the proximal part to the distal end. The maximum displacement values under the axial load of 1,500 N was in the following order: novel anatomical plate (1.2365 mm) < oblique T-shaped locking plate (1.314 mm) < two lag screws (1.3747 mm) < straight buttress plate (1.3932 mm). As the axial load increased, the stress value of the different internal fixation models gradually increased. The stress behavior of the same internal fixation model under different loads was similar. The maximum stress value under the axial load of 1,500 N was in the following order: novel anatomical plate (114.63 MPa) < oblique T-shaped locking plate (277.17 MPa) < two lag screws (236.75 MPa) < straight buttress plate (136.2 MPa).ConclusionThe patients with posterolateral plateau fractures fixed with a novel anatomical plate in standing, walking and fast running can achieve satisfactory biomechanical results, which lays the foundation for future applications. At the same time, clinical fracture types are often diverse and accompanied by damage to the soft tissue. Therefore, the ideal surgical approach and appropriate internal fixation must be selected based on the patient's injury condition.

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“…In addition, the posterior approach generally requires less needed reduction with clamps or bone tamps of surrounding tissue due to the gravity while in the prone position, which can also contribute to a shorter operative time 43 . Furthermore, the posterior approaches may require more experience compared with anterior approaches, and the results may be influenced by the learning curve 44 . The increased operative time observed in anterior approaches could be attributed to less experienced surgeons selecting the approach that offers limited visualization, resulting in longer operative times with increased soft tissue dissection 43 .…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Posterior Approach Versus Anterior Approach for Posterior Tibial Plateau Fractures

Tsai

Lin

et al. 2023

JBJS Reviews

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Background: Posterior tibial plateau fractures can lead to significant posttraumatic instability if not treated properly. It remains unclear which surgical approach achieves better patient outcomes. The objective of this systematic review and meta-analysis was to assess postoperative outcomes in patients undergoing anterior, posterior, or combined approach for posterior tibial plateau fractures. Methods: The PubMed, Embase, Web of Science, The Cochrane Library, and Scopus were searched for studies published before October 26, 2022, comparing anterior, posterior, or combined approaches for posterior tibial plateau fractures. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Outcomes included complications, infections, range of motion (ROM), operation time, union rates, and functional scores. Significance was set at p < 0.05. Meta-analysis was conducted with STATA software. Results: In total, 29 studies with a total of 747 patients were included for quantitative and qualitative analysis. Compared with other approaches, the posterior approach for posterior tibial plateau fractures was associated with a better ROM and shorter operative time. The complication rates, infection rates, union time, and hospital for special surgery (HSS) scores were not significantly different between surgical approaches. Conclusions: The posterior approach for posterior tibial plateau fractures offers advantages such as improved ROM and shorter operative time. However, there are concerns regarding prone positioning in patients with medical or pulmonary comorbidities and indications in polytrauma cases. Further prospective studies are needed to determine the optimal approach for these fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Posterior tibial plateau fracture treatment with the new WAVE posterior proximal tibia plate: feasibility and first results

Abstract: with details of the nature of the infringement. We will investigate the claim and if justified, we will take the appropriate steps.

Cited by 7 publications

References 20 publications

Treatment of tibial plateau fractures involving the posterolateral column using the extended anterolateral approach

Treatment of tibial plateau fractures involving the posterolateral column using the extended anterolateral approach

Finite element analysis of a novel anatomical plate in posterolateral plateau fractures

Comparative Analysis of Posterior Approach Versus Anterior Approach for Posterior Tibial Plateau Fractures

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